TMI - Too Much Information

I have worked my whole career in and around hospitals and doctors. We administrators joke affectionately about how nurses talk about bodily functions like we talk about spreadsheets. Very matter-of-factly, no sugar-coating.

Early the first morning (Tuesday, Donate Day +1) the transplant fellow checked my dressings and then she listened for bowel sounds. Hmmm? I wonder why she cares about my bowels? She knows they took my kidney, right?

After breakfast, I took a lap around the unit and came back to sit in a chair. The nurse came in and said I was looking good and then "Are you passing any gas yet?" Passing gas? I sound like a motor boat. It was so embarrassing. I asked Mack to talk real loudly when I had visitors so I could time my "episodes" to coincide with his talking. If I looked in pain, it wasn't pain - rather it was his queue to say something - anything. And say it now! I proudly reported my progress to the nurse. From her pleased expression, I knew I had passed the test - no pun intended.

Early the second morning (Wednesday, D+2) the fellow visited me again, removed the dressings and I saw my amazingly tiny incisions for the first time. As she again listened to my bowels, she said, "Have you had a bowel movement yet?" Wait a minute. Are you upping the ante? You didn't tell me I had to do that! I haven't eaten solid food since Saturday! I think my exact words were, "It ain't happening." I think I begged her to not make that a prerequisite of discharge. She said, "Well, we'll see how you do today." I was left unsure if I had to pass this new test before discharge.

Shortly after shift change, my new nurse came in and boldly asked, "Have you had a bowel movement yet?" OK enough already! What's up with the bowel movement?

She patiently explained that anesthesia slows your bowel functions and sometimes it takes a while for them to "wake" back up. They want to make sure everything is working again before I go home. She explained that getting constipated could be a very bad thing. Hello! You don't have to tell me that twice. I have four incisions in my belly.

When Mack and my sweetest best friend, Vicki, started texting each other about my "number 2" I knew it was time to take action. I asked for a peanut butter and jelly sandwich (purely psychological) and walked up and down the hallway several times. Late in the afternoon, I asked Mack to guard the door and say I was napping if anyone came to visit. I emerged a little while later and gave my nurse two thumbs up. Shortly after that I was on my way home. I guess I had successfully passed all their discharge criteria.

Thanks to the great transplant fellow and all the staff on Marburg 2. You made my stay very easy and pleasant despite the requirement to provide waaaay too much information about my bodily functions. Want to see a really cool spreadsheet?

Milk of Amnesia

There is a drug that anesthesiologists can give you that makes you forget all the unpleasant activity around the surgery. You are awake and able to respond and cooperate, but you don't remember a thing. If you have had it, it is pretty cool. It is a white, milky fluid and one of my wonderful doctor friends, Connie, told me they like to call it Milk of Amnesia.

The last thing I remember was the nurses unlocking the wheels on my stretcher and saying, "Here we go to the OR." According to Merrie, I was wide awake just talking up a storm. I like to talk. I apparently moved myself from the stretcher to the operating table and cooperated with all their instructions while bombarding them with questions of my own. Happily, I don't remember a thing!

The next thing I remember is a vague recollection of people coming and going from the recovery room. To me, only a second had passed, but it was really about 4 hours, I think. I have visions of Mack and Chris and Gail and Carol. I think I remember Greg and Pickle, too. My best doctor friend, Kristy, stood at the foot of my bed for a long time and then said, "She won't remember any of this. I'll be back in a little while."

I had no pain and no nausea (thanks Anethesiology, Merrie and Jeff). All I wanted to do was sleep a little longer.

Finally, I was ready to go to my room. I had two lovely ladies transporting me. When we got to the elevators I asked them if Robert was in surgery yet. They said his surgery was a little delayed and he was still sitting in the pre-op area. When I asked if I could see him, they did a quick u-turn and headed back. Everyone along the way just stared at us with quizzical looks wondering why we were coming back.

They pushed my stretcher in to the room where he was and I met his wife for the first time. He looked so happy. I think he was relieved to see me safe and well. We had a brief chat and I could feel how eager he was to see this day finally come.

I would not have traded that u-turn for anything. I am also glad that the Milk of Amnesia had worn off so that I can hold that memory forever.

Monday, Monday ...

In about eight hours I am having a nephrectomy. I am voluntarily having my kidney removed to donate to someone else.

WHAT!? They are going to poke holes in my belly, blow it up with air and pull my kidney out through a little slit. I MUST BE INSANE!! WHAT WAS I THINKING??

Last week my old best friend, Mindi, and I went to dinner. I told her that I didn't understand why everyone was making such a big deal. It couldn't be worse than a hysterectomy or a C-section. My kidney is only about the size of my fist and that is much smaller than a baby. Mindi, in her dry way, said, "And just when have you had a hysterectomy or a baby?" I admitted that I had had neither. So she said, "So, Pamela, you have no idea what you are talking about."

My mother used to say that all the Paulk kids had the unique ability to speak with great authority about subjects we know absolutely nothing about. Well, except my older brother, Keith, who actually does know something about everything. We have yet to stump him.

Mindi is right. I don't know what donating a kidney is like, but the staff have done a great of preparing me. I go in tomorrow morning at 5:30 a.m. My brother, Mack, my nephew, Chris and two of my best friends, Gail (new best friend) and Carol (best friend from work) will be there. They will sit watch in the waiting room for the next several hours.

Merrie from Anesthesiology kindly called me yesterday to talk about anesthesia. When I explained that I am claustrophobic, she said she would make sure I was warm and comfortable and that nothing would be put over my face until I was asleep. That was incredibly reassuring. She even said she could put me to sleep in a comfortable sitting position. She did warn me that my side would get stretched a lot with my arm over my head, so not to be alarmed. Hooray, mentor Kathy, for encouraging me to stretch.

I will wake up about four hours later that will feel like two seconds with one less kidney. I will stay in the hospital for a couple days and go home to recuperate. My recovery will take 4 - 6 weeks. I measure full recovery when I can get back to the gym and my pilates and yoga classes. They say a full six weeks before I am allowed to do that. I have a wonderful support system of family and friends who have volunteered to check on me, walk with me and feed me.

Thanks to everyone for all their notes and words of support. It has already been an extraordinary journey and it really hasn't even started yet.

I am ready for tomorrow - Monday.

I Know She Needed Fish

We lost our Dad early. I am the fourth of six kids and I was 17 when Dad died at the age of 56 - heart disease. Before he got sick he was full of energy and loved life. He and Mom loved nothing more than their six kids and he shamelessly bragged about us to anyone who would listen. But their love for fishing was a close second. We ate what they caught.

They went fishing every chance they got and if Mom couldn't go, one of us kids would go along with Dad. I did my share of fishing, but my younger brother, David, loved it the most and he and Dad spent many hours fishing together. David has Dad's same joie de vivre and when he walks into a room the volume goes up and people smile. David shared a story with me a few years ago that stuck with me.

He and Dad had been fishing when David was probably 9 or 10 and had a good catch (probably bass or brem). Dad drove a 1969 Volkswagen automatic stickshift - I learned to drive in that car. On the way home, Dad pulled off the road in front of a very modest house. Hearing a car drive up, a woman walk out on the porch. Dad yelled, "Get a pan. I've got some fish for you." She said, "I can't pay you for them." "No, I don't want money. I'm giving them to you. We caught more than we can eat."

When Dad returned to the car David said, "Dad, how do you know that woman?" He replied, "I don't, son, but I know she needed fish."

If you don't believe in legacy, here is the rest of the story. Years later, David pulled up to a modest house on the way home from fishing and gave an elderly woman some fish. She said, "You know, years ago a man in a Volkswagon used to stop every now and then and give me fish. I remember that there always a young boy with him." David's answer, "I was that boy."

People ask me why I would give my kidney to someone I am not related to. I just don't have a good answer. I just know he needed a kidney.

Though he has been gone 38 years next week, rarely a day goes by that I am not reminded of him in some way. He never knew me as an adult, but I hope he would be proud of the woman I have become.

Happy Father's Day. I wish you were here.

Starting the Conversation

As I walked across the Nelson-Phipps bridge this morning I could see a coworker and her son walking into the hospital entrance. I have worked with her for 9 years and have known her son since he was in elementary school. He is now taking college classes and works full-time here as well. He is a handsome young man with a beautiful spirit just like his mom.

She and I arrive on our floor at about the same time. She said, "Hey, funny to run into you. We were just talking about you. On the drive in this morning, my son said that he had read your blog last night and he asked me, 'Mom, could you do that? Could you give someone your kidney?'"

I don't know how the conversation ended, but I know that it started. Here is a young man who likely never would have had a conversation with this mother or anyone about organ donation. Now he has thought about it - thought about it enough to raise the question with his mother. A seed has been planted. Organ donation is now something real to him. That can never be erased.

It would be great if all families had this conversation. Signing your donor card and having it designated on your license is the first step. But make sure your loved ones know your wishes firsthand. If a tragedy strikes and your organs are available, even if you have that little heart on your driver's licence, the hospital will consider the wishes of your family. At their time of lose, this may be a painful decision. If you have told them your wishes, then just maybe they can find some comfort that your wish was to help someone else.

Later today, someone pulled out their wallet, pointed to the heart on their driver's license and asked me, "This does mean that if something happens to me, they will use my organs, right?" I said, "It tells the healthcare providers that that is your wish. Please go home tonight and tell your family so that they know it, too."

It may be an awkward conversation at first and I am not sure how to start it, but please start the conversation somewhere, anywhere. And please sign a donor card if you have not already.

My Inspiration

Is it a coincidence that I want to be a donor and I have two friends who have kidney transplants? Probably not. More than likely their friendship planted the seed in my mind without me or them even knowing that the seed was being planted.

My old best friend - I also have a new best friend, a best friend at work, a best friend at the gym, a best guy friend - you get the idea. Anyway, my old best friend moved to Baltimore a few years ago with her husband and they called to get a recommendation for new doctors. Specifically, he needed a nephrologist. That was when I learned he had a transplant. He had a rare condition as a child that caused both kidneys to stop functioning. Luckily, both his parents were a match and at the age of 21, he received his dad's kidney. You would never know that he has a transplant. Hmmmm... people with transplants look and act just like people without transplants.

I am on the board of a local non-profit that works on policy, legislation and programs to help remove barriers for lower wage and lower skill workers to open avenues for them to get and keep jobs with good pay and benefits. (I am doing them a great disservice by not explaining further, but it is Donate Day - 4 and I can only write so much.) I became close with one of the staff. I am not sure when, but somewhere along the way she told me that she had a kidney transplant. I never asked her the details, but I know that she received a cadaveric kidney when she was only 12 years old.

He is 43 and she is 36 now. They both have transplants that are over 20 years old. Without these kidneys, they would have died tragically young.

They are my inspiration. Whenever I get the least bit uneasy, I think of them. I felt the need to reach out to both of them this week when I needed a little dose of reassurance. They are the living proof that kidney donation gives back life. I value them in my life and know my life and others' lives would be less complete without them in it.

Everyone Needs a Mentor

Shortly after I volunteered to be a donor, the Transplant Office at Hopkins asked me if I wanted a mentor. I know and promote the value of mentoring in career development, so it sounded like a great idea. The coordinator said they would try to connect me with someone who I could relate to. Well, they weren't kidding!

In a few days they called me and gave me her number. They said she was about my age and had donated her kidney to her husband 3 - 4 years ago. The following Sunday I called the number they gave me....

"Hi, this is Pamela, Hopkins Transplant Office gave me your number as my mentor. I am considering donating a kidney and was wondering if we could talk."

In a loud, distant voice I hear. "Oh, Hi! I was expecting your call! But I am in Snow Mass! Right now I am at the top of the run about to come down! Can I call you when I get to the bottom!?"

The coordinator had hit a home run. Here was a woman full of life who had just donated a kidney. Her response was better than any brochure I could read.

We did talk when she got back to the lodge. She gave me some great practical advice including to do as much side stretching as possible before the surgery. She said she did not know why but her mentor (her uncle if my recollection is correct) had warned her that you would be very sore because your arm is over your head for most of the operation. She said she had not stretched as much as she should have and was definitely sore.

She said to walk as much as I can after the surgery even if it is only around my apartment. In a week, she could walk a block. She reminded that for the first few weeks I would have good and bad days and not to get discouraged. She emphasized over and over that my life would not be harmed in the least after the recovery period. And she is living proof of that.

I called her again last night to tell her I had a date scheduled for this Monday. First thing she said was, "Have you been stretching." I have! I got lots of encouragement and support and repeated cautions about following doctors orders to rest from her. Hmmmm....I wonder why she thinks that would be a problem for me?

I am learning that the donor/recipient community is larger than I expected. As I talk about it publically I hear of more and more people in my own extended circle who have given or gotten kidneys. I also hear too often of people who are waiting for a kidney or of people who have died waiting.

Thank you to my mentor for her encouragement. I need to go stretch now!